Systematic Literature Review on Psychiatric Comorbidities in Patients with Epilepsy

Objective: A systematic literature review was completed to clarify the prevalence of psychiatric comorbidities in people with epilepsy. Background: People with epilepsy (PWE) face increased risk of disability, poor quality of life, stigma, and premature mortality. Mental illness is also disproportionately common among PWE, which complicates medical management. Despite the importance of considering psychiatric conditions in epilepsy, the reported rate of psychiatric comorbidities in PWE is highly variable. There is a clinical need to clarify the prevalence of mental illness in PWE, and to understand the factors associated with their occurrence. Design/Methods: We completed a systematic literature review of original research articles that reported the prevalence of psychiatric comorbidities within a sample of PWE. Two researchers independently reviewed results from four electronic databases (Pubmed, PsycINFO, Ovid, and Cochrane) and finalized a list of 22 papers. The primary outcome extracted was the prevalence of psychiatric comorbidities as a percentage of the total sample of PWE. These values were then pooled and analyzed. Results: PWE were found to have increased frequency of multiple psychiatric conditions compared to the general population. Depression and anxiety were most common among PWE, with rates of 28% and 26% respectively. Other reported co-morbidities included post-traumatic stress disorder (7.3%), obsessive-compulsive disorder (3.5%) schizophrenia (2.9%), bipolar disorder (1.7%), and substance abuse (7.9%) abuse. Suicidality was also increased among PWE, with high rates of suicidal behavior (9.3%) reported in two studies. Conclusions: Our study confirmed that PWE are at increased risk of psychiatric comorbidities. However, future research is needed to study the relationship between epilepsy and psychotic disorders for which fewer studies report prevalence of comorbidity. Further analysis is needed to correlate psychiatric comorbidity with harmful behavior, seizure severity, and quality of life in PWE. Disclosure: Dr. Lu has nothing to disclose. Dr. Pyatka has nothing to disclose. Dr. Sajatovic has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Bracket, Otsuka, Sunovion, Neurocrine, Supernus, Health Analytics. Dr. Sajatovic has received royalty, license fees, or contractual rights payments from Springer Press, Johns Hopkins University Press, Oxford Press, UpToDate. Dr. Sajatovic has received research support from Otsuka, Merck, Alkermes, Janssen,.